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Managing Intersectoral Action for Health and
Development: Lessons from Slovenia
Peter Beznec Centre for Health and Development Murska Sobota
Working together for health equity, Vilnius, Lithuania, 27.11.2014
Pomurje in brief
• Population: 119.146 – micro region
• SDH:
• Unemployment 18% (SI 13%)
• GDP 65% of SI, 55% of EU
• 28,6% of population only primary school or less (SI 20,8%)
• 10,5% in life long learning (SI 16%)
• Brain drain
• Life expectancy lower than SI avg for men 3 and women 2 years
• Highest death from CVD 46,1%
• Highest premature mortality for men 32,4% (SI 29,4%. )
• Limited data about HI within the region
• CINDI lifestyle surveys show HI
Pomurje in brief
Assets • Natural resources (thermo-mineral and mineral waters, arable land, water and sun - energy) • Tradition in health tourism, agriculture, handcraft • Location & infrastructure (30 min to AT, HU, HR, 5 large cities within 250 km, connected with highway, railroad) Capacity for tackling HI and SDH • Partnership • Understanding health as development potential and vice versa
Health & development in Pomurje
2001-2006: IFH - Program Mura
2007-2013: SDH and HI
2014-2020: Wellbeing/ Q of life
Period 2001-2006
Health and development
Investment for health and development
Health
Social
development
Economic
development
REGIONAL DEVELOPMENT PLAN as a framework for
policies, programs and projects which relate to social
and economic determinants of health
Clear vision of Program Mura
to achieve better health and quality of life for the
people in the Pomurje region
to achieve the understanding of health as a development potential of the region and vice-versa:
development as the basis for better health
http://czr.si/files/murahealthinvest---arhiv.pdf
NGOs
CHD IPH
Primary Health
Care Centres
Hospital
Schools
Kindergartens
Local authorities
Employment Service
Regional & local development
agencies
Chamber of
Commerce & Industry
Agricultural
extension service
Tourist association
Food Industry
Health spa resorts
Local coordinators
Landscape
Park Goričko
CHD- Centre for Health & Development
IPH- Institute of Public Health Murska Sobota
MEDIA
Investing in Regional Partnership
HEALTHY COMMUNITY
IPH MS
HEALTHY ENVIRONMENT
KPG
HEALTHY FOOD
KSS
HEALTHY TOURIST OFFER
PTZ
Governmental working group on health
and sustainable development in Pomurje
RDA Mura
RDP Pomurje 2000+
PRESIDENT
VICE- PRESIDENT
PROGRAM COORDINATOR
REGIONAL PROGRAM MURA COUNCIL
Mechanism also at national level
HEALTH
HEALTHY FOOD
AGRICULTURE
FOOD INDUSTRY
• more fruit & vegetables
•ecological farming
•local supply chain
•safe & healthy food
HEALTHY
COMMUNITY
HEALTH
PROMOTION IN :
•local community
•marginal groups
•schools
•workplace
HEALTHY
TOURIST OFFER
•healthy & traditional
offer in gastronomy
•recreation programs
•prevention programs in
health spas
•Eco-tourism
HEALTHY ENVIRONMENT
Natural, living, socio- economic
Clear common objectives
PROJECT LET’S LIVE HEALTHY
LIFESTYLE:
NUTRITION
PHYSICAL
ACTIVITY
TO TAKE SELF RESPONSIBILITY FOR HEALTH
Source: RIPH MS
PERCEIVED CHANGE OF LIFESTYLE % PARTICIPANTS
NUTRITION (any change) 95 %
More vegetable 67 %
More fruit 53 %
Less fat 64 %
Less salt 36 %
More physical activity 36 %
Knowledge about healthy lifestyle 65 %
Information from workshops distributes
further 50 %
Source: RIPH MS
Healthy nutrition
Schools and kindergartens
Local restaurants
Health spas
Shops and markets
Local communities
Production site
Resolution on the National Programme
of Food and Nutrition Policy 2005-2010
Pilar 1: Food Safety
Pilar 2: Well- balanced and protective nutrition
Pilar 3: Sustainable local food
supply
Guidelines for healthy nutrition in
kindergartens, primary schools and
secondary schools (1)
launched by the Ministry of Health
in 2005
harmonised with the Ministry of
Education
implementation in 2006 and 2007
Healthy choice, an easy choice
Pomurje the land of health and friendly people
Health is included in regional development program
Partnership network with more than 25 local and regional partners
Alliances with international partners
Capacity accross the sectors in uderstanding the
SDH and IFH concept
Achievements by 2006
http://www.zzv-ms.si/si/zdravje-razvoj/
Strategija-Neenakosti-v-Zdravju.htm
Regional
strategy to
tackle
health
inequalities
Regional
development
program
2007-2013
Period 2007-2013
Social determinants of health
and health inequalities
Determinants of health (Dahlgren & Whitehead, 1991)
Health 2007-2013
Health inequalities
•Tackling inter- and intra- regional inequalities in health
•Increasing social inclusion
Healthy food, culinary
and development of the countryside
•Fruit and vegetable
•Organic Farming
•Short supply chains
•Safe food from farm to fork
•Alternative income generation
Healthy tourist offer
•Healthy and traditional offer in gastronomy
•Recreational programmes
•Prevention programmes in spas
•Ecotourism
•Culture and handcraft
Nature, environment and
health
•Natural living
• Sustainable mobility
•Water
•Biodiversity
Regional Partnership for Health and Development
Developing Health
Policies, priorities,
and programmes
across sectors
Building System
s for Delivery
Building Capacity
• identifying and understanding HI • implementing HIAP approach and cross sectoral action on SDH
• locally, regionally, nationally, internationally • WHO CC for capacity building in cross- sectoral investment for health
Transfer of good practices
- let’s live healthy
- regional strategies
to addres HI
Source: RIPH MS
Report on Health inequalities in Slovenia, 2011
•National Institute of Public Health •Statistical Office of RS •Institute for Macroeconomic Analysis and Development •Institute of Oncology Ljubljana •Centre for Health and Development Murska Sobota •WHO EURO
•Support from MOH
http://czr.si/files/neenakostivzdravjuknjbl-ang-web.pdf
Mortality by Slovenian administrative units, 2005–2009
(NIPH Database of deaths 2005-2009; SMARS)
Health inequalities in Slovenia, NIPH, 2011
Life expectancy at 30 relative to education and gender,
Slovenia, 2008 (Corsini, 2010)
Health inequalities in Slovenia, NIPH, 2011
Tackling health inequalities- challenges
Health inequalities in Slovenia, NIPH, 2011
• Health and tackling health inequalities integral part of Slovenian development strategy as well as other development documents
• National strategic framework for tackling health inequalities
• Effective cross- sectoral mechanisms
• Regular monitoring of health inequalities in the context of development progress and wellbeing
• Supporting international initiatives to tackle health inequalities
Focus on Vulnerable groups Disabled people
• Inclusion through sport and recreation • Building capacity of NGO for disabled people • Awareness raising for inclusion of disabled people in the society
Roma population • Training for better employability (new skills) • Promotion of healthy life style • Promotion of social inclusion of Roma in wider society (tourist product, demonstration of new skills)
From Physical activity to Active Mobility
Promoting healthy and nature friendly way of transport • Different target groups – focus on early start (Active Access, Bambini, Healthy) • Long term support – partnership with community (Walking Bus)
Sustainable transport • Establishment of Local support group – Community • Sustainable urban mobility plan • Local Action plan for soft mobility measures
Period 2014-2020
Sustainable society
- Social activation and tackling health and social ineqaulities
- Active and healthy aging
- Deinstitutionalisation and community care for elderly, people with
mental illnesess, disabled and vulnerable groups, paliative care
- Strenghtening primary care and public health, development of
integrated social and health services with strengthening of cross-
sectoral provider’s networks
- e- health
Health in National development priority for Inclusive growth 2020: Social inclusion, combating poverty & health
Norwegian financial mechanism 2009- 2014
used for strenghtening PH and addressing HI
Objective
•reduced inequalities in health between user groups
• prevention of life-style related diseases
• improved mental health services
•Predefined project implemented by NIPH in cooperation with
primary health care on mainstreaming health equity principle
into prevention programs
•130 project applying for grant, besic requirement in the
tender was cross- sectoral partnersip
Sustainable society
• active and healthy aging • healthy lifestyle • social inclusion and health equity •Integrated health and social services
• sustainable tourism • local food supply • energy self-suficiency • revitalisation of environmental resources
Green workplaces
Wellbeing
Sustainable living
Sustainable development
Vision of Pomurje
Quality of life Development
of potentials
RDA Mura
New development strategy of Pomurje focus on specificity of the region
vision potencials
specialisation
strategic
objectives priorities
key projects
5 working groups RDC
22 meetings (okt 12 – jul 13)
Draft of RDP ( 25.3.2013)
More than 140 experts
RDA Mura
Results 10 mesures in the area of health, Q of life, social inclusion and equal
opportunities
Pomurje
1 development specialisation
5 development priorities
19 investment areas
95 measures
223 project proposals
3.2 health
3.4 soc. inclusion
10 health and social inclusion
29 health and social inclusion
RDA Mura
Conclusions
• move from sectoral to broader society objectives • support your arguments with evidence • build partnerships and alliances on different levels (local, regional, national, international) • link with established practices and infrastructure • plan for continuity • evaluate and document progress and failures • allow time and resources for capacity building
